tbuckley/cabot-search huggingface dataset:
Abstract 13880: Natural Language Processing for Adjudication of Heart Failure Hospitalizations in a Multi-Center Clinical Trial
Authors: Jonathan Cunningham, Pulkit Singh, Christopher Reeder, Brian Claggett, Pablo-Miki Marti Castellote, Emily Lau, Shaan Khurshid, Puneet Batra, Steven Lubitz, Mahnaz Maddah, Anthony A Philippakis, Peter Finn, Akshay S Desai, Patrick T Ellinor, Orly Vardeny, Scott Solomon, Jennifer E Ho
Journal: Circulation (2023)

Background: The gold standard for outcome adjudication in clinical trials is chart review by a physician clinical events committee (CEC), which requires substantial time and expertise. Automated adjudication by natural language processing (NLP) may be a more resource-efficient alternative. We previously developed the Community Care Cohort Project (C3PO) NLP model to adjudicate heart failure (HF) hospitalization within one healthcare system. Aim: To externally validate the C3PO NLP model against CEC adjudication in the INVESTED trial Methods: The INVESTED trial evaluated influenza vaccination in 5260 patients with cardiovascular disease at 157 North American sites. A central CEC of 21 physicians adjudicated the cause of hospitalizations from medical records. We applied the C3PO NLP model to 4060 INVESTED medical record dossiers and evaluated agreement between the NLP and final consensus CEC HF adjudications by kappa statistic, sensitivity and specificity. We fine-tuned the C3PO NLP model (C3PO+INVESTED) and trained a de novo model in half the INVESTED hospitalizations, and evaluated these models in the other half. NLP performance was benchmarked to CEC reviewer inter-rater reproducibility. Results: 1074 hospitalizations (26%) were considered HF by the CEC. There was high agreement between the C3PO NLP and CEC HF adjudications (agreement 87%, kappa 0.69). C3PO NLP model sensitivity was 94% and specificity was 84%. The fine-tuned C3PO and de novo NLP models demonstrated agreement of 93% and kappa of 0.82 and 0.83, respectively. CEC inter-rater reproducibility was 94% (kappa 0.85). Conclusion: In external validation, a single-center NLP model for HF adjudication was accurate relative to the gold-standard CEC in an external multi-center clinical trial. Fine-tuning the model improved agreement to the level of human reproducibility. NLP may improve the efficiency of future multi-center clinical trials by accurately adjudicating clinical events at scale.
Abstract 13852: Sex Differences in Blood Pressure Reduction and Cardiovascular Outcomes in Patients With Resistant Hypertension Undergoing Radiofrequency Renal Denervation: Global SYMPLICITY Registry DEFINE
Authors: Anastasia S Mihailidou, Felix Mahfoud, Markus P Schlaich, Roland E Schmieder, Krzysztof Narkiewicz, Luis M Ruilope, Bryan Williams, Martin Fahy, Michael Boehm, Giuseppe Mancia, Doug Hettrick, Joachim Weil
Journal: Circulation (2023)

Introduction: Hypertension (HTN) prevalence and outcomes differ by sex. Radiofrequency renal denervation (RF RDN) safely reduces blood pressure (BP) in patients with resistant HTN. Hypothesis: After RF RDN, there are no sex-based differences in BP changes and cardiovascular (CV) outcomes. Methods: The Global SYMPLICITY Registry (GSR) DEFINE is an all-comer registry of patients with uncontrolled BP undergoing RF RDN. BP changes (analysis of covariance [ANCOVA] adjusted for baseline BP and age), CV death, stroke, myocardial infarction (MI) rates at 3yrs were compared between sexes with office systolic BP (OSBP) ≥140mmHg, prescribed ≥3 anti-HTN drugs. Results: Patients enrolled up to March 2023 were included (N=2502, female=1062). Females were older (62 vs 59 y; p&lt;0.0001), less likely to have a history of sleep apnea (12.5 vs 25.0% p&lt;0.0001), cardiac disease (45.2 vs 50.3%; p&lt;0.0012) and smoking (19.1 vs 41.3%; p&lt;0.0001). Body mass index, rates of diabetes and chronic kidney disease, number of anti-HTN drugs (5.1±1.5 in both sexes; p=0.88) and 24-hr SBP were similar by sex. Baseline OSBP was higher in females (174±23 vs 169±19mmHg; p&lt;0.0001). After 3yrs, OSBP significantly decreased in both sexes from baseline (female: -21.5mmHg vs male: -20.4mmHg; ANCOVA adjusted difference: 3.2mmHg [95% CI: 0.5 to 6.0; p=0.021]). There was no difference in 24-hr SBP change (Figure 1A) or number of anti-HTN drugs by sex. CV death rate was significantly higher in females (4.1% vs 2.1% vs p=0.024), but MI rate was significantly lower in females (1.3% vs 3.5%; p=0.007). Stroke rate was similar by sex (Figure 1). Conclusion: Females with resistant hypertension referred for RF RDN were older, had higher OSBP with fewer comorbidities compared to males. Despite similar BP reductions up to 3yrs after RF RDN, CV death rate in females was greater than males. These results suggest the need for sex specific analyses and control of HTN in females.
Abstract 12545: Inpatient Physical Therapy Use Among US Veterans Hospitalized for Heart Failure
Authors: Vincenzo B Polsinelli, Bissilola Nyonyotsi, David B Bekelman, Paul L Hess, Evan P Carey, Kelsey Flint
Journal: Circulation (2023)

Background: Physical debilitation is a common adverse effect of heart failure (HF) hospitalization and is associated with adverse outcomes. Hypothesis: Inpatient physical therapy (PT) mitigates the adverse effects of HF hospitalization, and improves outcomes in patients hospitalized with HF. Methods: Patients with an index hospitalization for HF at a VA facility between January 1, 2013 to December 31, 2017 were identified. Change in PT use over time was evaluated using the Cochran-Armitage trend test. After propensity matching, the impacts of inpatient PT exposure on 90-day all-cause mortality, and a composite of all-cause mortality and readmission were assessed. Results: Of 44,299 patients admitted with HF, 11,685 (26.3%) received inpatient PT. Compared with those who did not receive PT, those who did were older (70.7 vs 75.8; P&lt;0.001), more frequently White (70.0% vs 74.0%; P&lt;0.001), and had a longer length of stay (3.9 vs 7.4; P&lt;0.001). The proportion of patients who utilized PT increased from 24.9% to 55.4% during the study period (P&lt;0.001). After propensity matching, inpatient PT use was associated with worse all-cause mortality (HR: 1.24 [1.14 - 1.36]; P&lt;0.0001) ( Figure ), and a composite outcome of death or all-cause hospitalization (HR: 1.07 [1.02 - 1.12]; P=0.0038) at 90 days. Conclusions: Inpatient PT use significantly increased from 2013 to 2017. After propensity matching, utilization of PT services was associated with adverse outcomes.
Abstract 12529: Exercise Patterns and Body Mass Index in a Large Cohort of Patients With Anomalous Aortic Origins of Coronary Arteries
Authors: Thomas S Przybycien, Kimberly B Gray, Sameer Sadiq, Sandra Mihail, Tam T Doan, Shagun Sachdeva, Dana Reaves-O'Neal, Ziyad Binsalamah, Silvana M Molossi
Journal: Circulation (2023)

Introduction: Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in the young. Exercise patterns in relation to BMI and surgery status are lacking. Hypothesis: Exercise patterns are variable in AAOCA and relate to BMI and surgery. Aim: To identify differences in exercise patterns and BMI in patients with AAOCA and their relation to surgery status. Methods: Single-center retrospective study of 573 patients with AAOCA (median age = 11.9 years, IQR 6-15), 63% males. Exercise patterns were classified as recreational or organized/competitive. BMI percentiles were stratified as normal (5 th to ≤ 85 th %ile), overweight (85 th to ≤ 95 th %) and obese (≥ 95 th %ile). Exercise patterns and BMI were compared across demographic parameters, presence of ischemia, and surgery status. Mann-Whitney U test was for non-parametric and χ 2 test for categorical variables. Results: Two-thirds of patients exercise recreationally, 1/3 are overweight (BMI &gt; 85 th %ile) and 20% are obese (BMI &gt;95 th %ile) (Table 1). Those who had surgery were more likely to exercise competitively (24% vs 15%, p=0.026). Myocardial ischemia was more likely in those who were exercise restricted (34% vs 14%, p=&lt;0.001). There was no difference in BMI percentile in those with ischemia or who exercised competitively (Table 2). Conclusion: Most patients with AAOCA exercise recreationally and 1 in 5 is obese. Surgery positively relates to competitive exercise. BMI or exercise patterns are unrelated to ischemia but associated with exercise restriction. Future studies are needed to determine optimal exercise recommendations to promote active lifestyle while minimizing the risk of sudden death.
Abstract 12562: <i>DYRK1A/PPARG/EGR1</i> Pathway Elicits Endothelial Dysfunctions and Predispose to Developing Pulmonary Hypertension in Down Syndrome
Authors: Hidehiro Suginobe, Jun Narita, Ryo Ishii, Kazutoshi Udea, Chika Yoshihara, Renjie Wang, Atsuko Ueyama, Kazuhisa Hashimoto, Masaki Hirose, Hidekazu Ishida
Journal: Circulation (2023)

Introduction: Patients with Down syndrome (DS) have a higher prevalence of pulmonary arterial hypertension (PAH). Pulmonary vascular endothelial dysfunction has been recognized to be one of the predisposing factors to develop PAH, but pathophysiology of pulmonary endothelial cells in DS specific PAH is still unknown. Hypothesis: Endothelial dysfunctions contribute to developing PAH in DS. Methods: Induced pluripotent stem cell-derived vascular endothelial cells (iPSC-ECs) from DS patients were utilized for analyzing cellular and mitochondrial functions. A Cre-loxP mediated isogenic correction line of disomy 21 was established and used as a control. Results: DS-iPSC-ECs showed increased apoptosis, reduced angiogenesis, increased mitochondrial reactive oxygen species, and decreased ATP production, which were all consistent with features of endothelial dysfunctions previously reported in other types of PAH. RNA-seq revealed increased expression of EGR1 in DS-iPSC-ECs, and its inhibition restored cellular and mitochondrial dysfunctions, demonstrated by si EGR1 and pioglitazone treatment. Moreover, we revealed that increased expression of DYRK1a , one of the major pathogenic genes in DS critical region on chromosome 21, led to elevated EGR1 expression thorough PPARG suppression. These experimental results were reinforced by the observations that pulmonary ECs of a DS patient with severe PAH also exhibited increased EGR1. Conclusions: DYRK1A/PPARG/EGR1 pathway in DS is responsible for endothelial dysfunctions and might be a new therapeutic target for DS specific PAH.
Abstract 16944: Risk Stratification With Hemodynamic Gain Index and Peak Rate-Pressure Product in Patients With Chronic Heart Failure Undergoing Treadmill Exercise Testing
Authors: Thanat Chaikijurajai, J. Emanuel Finet, Yuping Wu, Erik H Van Iterson, Serge C Harb, Wael A Jaber, Wai Hong W Tang
Journal: Circulation (2023)

Introduction: We recently demonstrated the combined prognostic value of two simple non-invasive parameters obtained from treadmill exercise testing in patients with HFrEF, the hemodynamic gain index (HGI) and peak rate-pressure product (pRPP). However, their prognostic value is yet to be validated in patients with undifferentiated HF syndrome. Hypothesis: Both HGI and pRPP predict all-cause mortality in patients with chronic HF. Methods: We identified 126,356 consecutive patients undergoing treadmill exercise testing for HF symptom evaluation between 1/1991-2/2015. Patients with a confirmed diagnosis of HF were included. HGI was calculated from [(SBPpeak x HRpeak) - (SBPrest x HRrest)]/(SBPrest x HRrest), and pRPP was calculated from SBPpeak x HRpeak. Hazard ratios per doubling of HGI and pRPP for all-cause mortality were estimated using multivariable Cox regression models with adjustment for traditional cardiovascular risk factors and exercise testing parameters (chronotropic reserve index, METs, abnormal heart rate recovery, and total exercise time). Optimal cut-off for HGI and pRPP were determined by the Youden’s index. Kaplan-Meier plots with log-rank test across patients with low or high HGI and pRPP were used. Results: There were 5,940 patients with symptomatic HF diagnosis included in the analysis (mean age 56.2±12.4 years, 68.1% male, 46.5% with CAD, 55.8% with beta-blocker use). During the median follow up of 7.1 years, 2,222 (37.4%) patients died. Higher both HGI and pRPP were associated with a lower risk of mortality (hazard ratio 0.85 [0.81-0.90] and 0.72 [0.62-0.84], respectively, all P &lt;0.001). Optimal cut-off values for HGI and peak RPP were 1.06 and 18,966, respectively. Figure 1 shows Kaplan-Meier plots across patients with low and high HGI and pRPP (log-rank P &lt;0.001). Conclusions: Both HGI and pRPP are predictors of mortality in patients with chronic HF and can be used for prognostication and referral for advanced HF therapy evaluation.
Abstract 19180: Early Rhythm Control is Associated With Improved Outcomes in Hypertrophic Cardiomyopathy Patients With Atrial Fibrillation
Authors: Muhammad Talha Ayub, Gautam Rangavajla, David Newhouse, Floyd W Thoma, Aditya Bhonsale, Andrew Voigt, Suresh R Mulukutla, Alaa Shalaby, Nathan A Estes, Sandeep Jain, Samir Saba, Krishna Kancharla
Journal: Circulation (2023)

Background: Atrial fibrillation in hypertrophic cardiomyopathy (HCM) patients is associated with worse outcomes with regards to stroke, heart failure hospitalization and death. Contemporary data on Rhythm control (RyC) strategies and outcomes in HCM patients is limited. Objectives: We aimed to assess the clinical characteristics of HCM patients with AF receiving RyC (antiarrhythmic drug and/or catheter ablation) vs no rhythm control (NRC) and compare clinical outcomes between the two groups. Methods: We analyzed the electronic health records of the University of Pittsburgh Medical Center, a large multi-hospital system, between 2010 and 2022. Differences between baseline demographics, cardiovascular risk factors, and comorbidity burden were evaluated with t tests. Adjusted Cox proportional hazards and Kaplan-Meier analyses were performed to evaluate associations between use of rhythm control and all-cause age-adjusted mortality. Results: A total of 552 patients with HCM and AF were analyzed, of which 118 received RyC and 434 NRC. The RyC group was relatively younger (age 64 vs 70), received initial evaluation by a cardiologist (70% vs 57%), had lower CHA2DS2VASC scores (mean 2.5 vs 3.1) and fewer comorbidities (mean Elixhauser scores 3.0 vs 4.7). There were no significant differences in either ejection fraction or left atrial diameter between the groups. Among RyC patients, 38 received catheter ablation and 80 received antiarrhythmic drug as the initial RyC strategy. Over a median follow up of 2.9 years (IQR 0.96-6.0), use of RyC was associated with decreased mortality after adjustment for age, Elixhauser score, and CHA2DS2VASC score (HR 0.54, 95% CI 0.30-0.95, p&lt;0.05, figure 1). Conclusion: Rhythm control in HCM and AF patients is associated with better outcomes as suggested by decreased overall mortality. Prospective studies are needed to establish the best RyC strategy in this cohort.
Abstract 12513: Anti-Inflammatory Effect of Statin Among Patients With Rheumatoid Arthritis: A Network Meta-Analysis of Randomized Controlled Trials
Authors: Vikash Jaiswal, Akash Jaiswal, Muhammad Hanif, Mayank Jha, Abdelrahman M Attia, Shiva Gupta, Alaa Ramadan, Marina Saleeb, Song Peng Ang, Kriti Kalra
Journal: Circulation (2023)

Background: Rheumatoid arthritis (RA) have shown to be associated with a higher risk of acute coronary syndrome and atrial fibrillation. However, the impact of statin among RA patients is not well studied, with conflicting results. Objective: We aim to compare the anti-inflammatory effect of different statin drugs among patients with rheumatoid arthritis in this network meta-analysis (NMA). Methods: We performed a systematic literature search on the electronic database for relevant randomized controlled trials (RCTs) from inception until 25th May 2023. A network meta-analysis was conducted to evaluate the anti-inflammatory effect of different statin drugs among RA patients. We presented results as mean difference (MD) and 95% confidence interval. Results: A total of 16 RCTs with a total of 3,886 patients (1,938 in the statin group and 1,948 in the non-statin group) were included. The network meta-analysis showed that Atorvastatin was the only intervention that significantly decreased the mean difference of all the inflammatory predictors including ESR (MD= -6.77, 95% CI= [-9.52, -4.01], P&lt;0.01), CRP (MD= -2.93, 95% CI= [-5.06, -0.79], P&lt;0.01), DAS28 (MD= -0.62, 95% CI: [-0.85,-0.39], P&lt;0.01); and IL-6 (MD= -9.28, 95% CI= [-16.04,-2.53], P&lt;0.01) in RA patients when compared to placebo. However, Atorvastatin showed no statistically significant difference for TNF compared to Placebo (MD: -31,51 with 95% CI [-75.54,12.52], P = 0.16). Regarding the other interventions, they showed no significant effect on the mean difference of any of the inflammatory markers. Conclusion: The findings of our study indicate that atorvastatin is associated with a significant decrease in the inflammatory markers among rheumatoid arthritis patients compared with other statin therapy. Overall, these results have significant implications for patients with RA who would benefit from the stain anti-inflammatory effect.
Abstract 19163: A Rare Case of Pericarditis as an Initial Manifestation of Rheumatoid Arthritis
Authors: Muhammad Majid, Aro Daniela Arockiam, Zachary Yaker, Mustafa Atar, Ankit Agrawal, Ashwin Kumar, Allan L Klein
Journal: Circulation (2023)

Case Presentation: A 69-year-old male with a history of chronic recurrent pericarditis presented with a 3-week episode of chest pain. Despite treatment with ibuprofen, colchicine, prednisone, and anakinra, he experienced multiple flares upon attempting to wean off anakinra. His current workup revealed an elevated C-reactive protein and an echocardiogram showing a small pericardial effusion. Cardiac magnetic resonance imaging showed mild pericardial late gadolinium enhancement and increased pericardial signal on T2 STIR imaging, confirming a flare of recurrent pericarditis. The patient was started on rilonacept while being weaned off anakinra. During a follow-up after 3 months, the patient reported new onset polyarthralgia, prompting a referral to rheumatology. Rheumatoid factor was negative, but anti-citrullinated protein antibodies were positive, leading to a diagnosis of rheumatoid arthritis (RA). Azathioprine was added to the treatment regimen alongside rilonacept. Discussion: The patient's recurrent pericarditis was initially considered idiopathic but, with the subsequent RA diagnosis, it was suspected that RA may have been the underlying cause. While pericarditis is a known cardiac complication of RA, it is uncommon for pericarditis to be the initial manifestation of RA. Anakinra and rilonacept are both interleukin-1 (IL-1) inhibitors, with anakinra being FDA-approved for RA treatment. However, rilonacept has not been extensively studied in patients with RA. The case suggests that the use of certain medications may have masked RA symptoms, and as those medications were tapered, the RA symptoms became more evident. This case highlights the possibility of idiopathic pericarditis evolving into an autoimmune etiology, such as RA, over time. The combination of rilonacept and azathioprine for treating RA has limited evidence, emphasizing the need for further research in this area.
Abstract 12561: Intravascular Lithotripsy Use for Percutaneous Fontan Pathway Rehabilitation in an Adult With Fontan Pathway Obstruction
Authors: Santiago F Galeano Lovera, Peter Pollak, Sabrina D Phillips, Carolyn Gonzalez, Allison K Cabalka, Katia M Bravo Jaimes
Journal: Circulation (2023)

Introduction: Fontan pathway obstruction is a serious complication characterized by an anatomical or functional narrowing anywhere in the cavo-pulmonary pathways. Here we report the first case where an innovative Fontan conduit rehabilitation procedure with intravascular lithotripsy was used achieving a significant increase in the pathway size. Case: A 28-year-old male with tricuspid atresia status-post Fontan palliation (age 23 months) with bare metal stent implant to treat obstruction at age 15, presented with syncope, ascites and varicose veins. Imaging studies revealed a cirrhotic liver morphology and Fontan pathway obstruction with minimal diameter of 12 mm. Cardiac catheterization confirmed severe Fontan conduit obstruction in addition to LPA stenosis. Serial covered Cheatham-Platinum stents were implanted for conduit coverage followed by Palmaz stents. Non-compliant Atlas balloon dilation to 20 atm was performed without expansion of the Fontan pathway beyond 12 mm due to severe calcification. A 7.0 x 60 mm shock-wave lithotripsy balloon was added alongside the Atlas balloon to modulate the heavily calcified wall with subsequent expansion of the conduit to 21 mm after inflating the Atlas balloon to 14 atm. Discussion: Several studies demonstrated that transcatheter stenting of stenotic Fontan conduits can be safely performed. Intravascular lithotripsy has emerged as a novel therapy for the treatment of coronary vascular calcification. We report the first case of an innovative percutaneous Fontan conduit rehabilitation procedure using a lithotripsy shock wave balloon in an adult with severely calcified Fontan pathway obstruction and prior stents, achieving a 75% increase in the pathway size without significant complications. Further studies are needed to evaluate the long-term safety and efficacy of this novel approach, but this case presents an exciting option for future directions in the percutaneous treatment of Fontan pathway obstruction.
Abstract 16935: Distressed Community Index in Patients Undergoing Carotid Artery Stenting in Medicare-Linked Vascular Quality Initiative Registry
Authors: Carmen S Pajarillo, Gaelle Romain, Jacob Cleman, Lindsey Scierka, Scott Grubman, Christopher Schenck, Jonathan Kluger, Kim G Smolderen, Carlos Mena-Hurtado
Journal: Circulation (2023)

Introduction: Patients with high community-level socioeconomic distress have worse cardiovascular outcomes, yet its impact on carotid artery stenting (CAS) outcomes is unknown. We assessed the association between the Distressed Community Index (DCI), a zip-code level measure of community distress, with post-CAS mortality and stroke. Methods: We used the Vascular Quality Initiative database linked with Medicare claims outcomes data to identify patients undergoing CAS between 2015 and 2019. From a time-dependent ROC curve and using Youden index, we classified patients as high community distress if DCI≥65. Thirty-six-month cumulative mortality incidence using Kaplan-Meier by DCI groups, and hierarchical Cox regression with random intercept for site for linear DCI were used. For stroke, we used 36-month cumulative incidence function by DCI groups, and Fine and Gray models accounting for competing risk of death for linear DCI. Models were later adjusted for patient and procedural characteristics. Results: The final complete-case cohort included 8,595 patients (2,580/30% DCI≥65), had a mean age of 74.7 (±7.8) years, was 92.7% white and 97.6% non-Hispanic/Latino. The 36-month cumulative mortality incidence was similar in both groups (26.0% vs 22.5%, P=0.236). A 10-point increase in DCI did not increase mortality risk (unadjusted HR 1.00; 95% CI 0.98-1.03 and adjusted HR 1.01; 95% CI 0.87-1.17). At 36 months the high community distress group experienced higher stroke risk (29.8% vs 22.9%, P=0.008). However, a 10-point increase in DCI did not increase stroke risk (unadjusted sub-HR: 1.01; 95% CI 0.99-1.03, adjusted sub-HR: 1.00; 95% CI 0.98-1.02). Conclusions: In this selective set of patients with underrepresentation of demographic groups, for those who get prioritized to CAS, higher community distress was associated with an increased unadjusted 36-month stroke risk by DCI group. However, a 10-point increase in DCI was nonsignificant regardless of adjustment.